The effect of esketamine on perioperative neurocognitive dysfunction in elderly patients who underwent gastrointestinal tumor surgery: a randomized double-blind controlled study

Abstract Background: We aimed to whether esketamine induction and maintenance of general anesthesia could reduce the incidence of perioperative neurocognitive dysfunction (PND) in elderly patients undergoing gastrointestinal tumor surgery and explore the related mechanisms preliminarily. Patients and methods: A total of 153 elderly patients were divided into two groups: a control group (group C, n=75) and an esketamine group (group K, n=78). In group K, 0.3 mg/kg esketamine was injected intravenously during anesthesia induction, and 0.3 mg·kg-1·h-1 was injected intravenously to maintain anesthesia. In group C, esketamine was replaced with an equal volume of normal saline. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality 1 day before surgery and at 1, 3, 7, and 30 days after surgery. A battery of neurological tests was used to assess cognitive function 1 day before surgery and 7 and 30 days after surgery. Serum IL-6, TNF-α, NSE and Aβ1~42 concentrations were tested by enzyme-linked immunosorbent assay before surgery, at the end of surgery and 1 day after surgery. Results: The incidence of PND in group K at 7 days after surgery was lower than that in group C (P<0.05). Compared with that in group C, the PSQI score in group K was lower at 1 and 3 days after surgery (P<0.05). Compared with those in group C, the TNF-ɑ concentration in group K were lower both after surgery and 1 day after surgery (P<0.05), and the IL-6, NSE and Aβ1-42 concentration were lower at 1 day after surgery (P<0.05). Conclusion: The use of esketamine for anesthesia induction and maintenance in elderly patients undergoing gastrointestinal tumor surgery inhibited inflammation, alleviated neuronal injury and degeneration, improved postoperative sleep quality and cognitive function, and reduced the incidence of PND.